Mr. Wilson, thank you for your indepth interview with BCBS's smirking VP re: insurance coverage. My story? I am basically a healthy person, now on Medicare Plus Blue part D. Boniva is the only prescription drug I have been taking. Now, BCBS refuses to cover it -- $55. covered and $97. not covered. When asked, a CVS pharmacist said "insurance companies create hurdles for prescription drug users so that users will give up on doctor prescibed drugs and take generics. I asked my gynecologist's office about generic drugs and a nurse said "the office doesn't employ "step therapy," as required by the insurance company "Fail First" requires I try generic drugs. Afterward, if I have an adverse reaction to generics- now called "collateral damage" - I might use Boniva. This satisfies the company's "Fail First policy." Then, I spoke to my primary-care physician: He said "insurance companies create hoops for us to jump through too." So, he wrote a letter for "Prior Authorization" for me to continue taking Boniva. Blue Cross denied the request and sent me a several-paged response for a "redetermination notice- denial of medicare prescription drug coverage stating, "There was no indication of trial and failure or contraindication to generics or lower tier drugs, "Request-denied." I might take it to another level responding within 60 calendar days. Medicare Part D was created by Congress to manage access to prescription drugs. January 2009, Medicare added new rules...as a way to utilize management tools to create higher profitability in despensing certain pharma which in turn creates a higher level of cost sharing. Most revealing is the "why" in this new policy: In the past, some network providers may have dispensed high doses of narcotics to drug abusers thus, the insured groupings have been redefined; the health-maintenance insured with drug abusers! source: UCP:Press Rm. Maybe Hertzel visibly reflected his knowledge of this fact.

This story is very biased. I am a pharmacist in Florida and under Florida law, pharmacies are required to dispense generics unless the doctor or patient says no. The chain I work for always prints on the patient's paperwork that they are receiving the generic. If the patient does not want the generic, we change it back. Patients have a right to regulate what they take. I have never argued with a patient that they have to take the generic. If I don't believe that a generic is best for a patient, I won't give it to them. Do not paint pharmacists and pharmacies as evil, money grubbing people. We care a great deal for our patients. We do not make the generics versions of medications. We rely on the FDA to regulate the companies that do. If a generic was approved by the FDA, we have to believe that all the correct testing was done and were found to fall within the limits set forth by the government. If you do not think the generics are any good, then attack the companies who make them and the government that approves them.